Key result
Concomitant coarctation in BAV links to ~45% lower likelihood of significant aortic dilatation versus isolated BAV.
Why the study?
Concomitant aortic coarctation is considered an aggravating risk factor in BAV aortopathy, but recent studies in younger cohorts showing smaller aortic diameters required confirmation in adult populations.
Does concomitant aortic coarctation affect the degree of aortic dilatation in adult patients with bicuspid aortic valve compared to isolated bicuspid aortic valve?
Cohort (n=969)
Does concomitant aortic coarctation affect the degree of aortic dilatation in adult patients with bicuspid aortic valve compared to isolated bicuspid aortic valve?
Odds Ratio: 0.55 (95% CI 0.3–1.01)
p-value: p=0.05
In adult patients with bicuspid aortic valve, concomitant aortic coarctation is associated with less pronounced dilatation of the tubular ascending aorta, challenging the assumption that it acts as an aggravating risk factor for aortopathy.
Background In bicuspid aortic valve (BAV) aortopathy, concomitant aortic coarctation (cBAV) is considered an aggravating risk factor which may indicate earlier prophylactic intervention. This assumption is challenged by recent studies in children or young adults, reporting smaller aortic diameters in cBAV patients compared to those with isolated BAV disease (iBAV), but these findings should be confirmed in adult patient populations. Aim To assess the association between aortic coarctation and aortic dilatation in adult BAV patients. Methods and results In a prospective cohort study, we included 141 cBAV patients and 828 iBAV patients from outpatient clinics. Maximal diameters of the aortic root and tubular ascending aorta were measured on transthoracic echocardiograms (TTE). Aortic diameters, significant aortic dilatation at baseline (≥50 mm or Z-score≥4) and annual aortic growth rates were compared between groups taking possible confounders into account. Compared to iBAV patients, cBAV patients had smaller crude and adjusted diameters (adjusted mean difference: -3.27 mm [-4.49 mm; -2.05 mm]) and a lower likelihood of significant aortic dilatation at baseline (adjusted OR [95% CI]: 0.55 [0.30;1.01], p = 0.05). We observed no differences in aortic root dimensions or in aortic growth rates between cBAV and iBAV patients. Conclusion cBAV was associated with less pronounced dilatation of the tubular ascending aorta in adult BAV patients.
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Wulffeld et al. (2026) conducted a cohort in Bicuspid aortic valve (BAV) aortopathy (n=969). Concomitant aortic coarctation vs. Isolated bicuspid aortic valve (iBAV) was evaluated on Significant aortic dilatation at baseline (≥50 mm or Z-score≥4) (OR 0.55, 95% CI 0.30-1.01, p=0.05). Concomitant aortic coarctation in adult bicuspid aortic valve patients was associated with a lower likelihood of significant aortic dilatation at baseline compared to isolated BAV (OR 0.55; 95% CI 0.30-1.01; p=0.05).
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